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Treatment of bacterial meningitis with intravenous amoxicillin
Insights
Intravenous amoxicillin sodium effectively treated bacterial meningitis in children, showing comparable results to ampicillin. Drug penetration into cerebrospinal fluid (CSF) decreased over the treatment course.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Bacteriology
Background:
- Bacterial meningitis remains a serious childhood infection.
- Parenteral amoxicillin offers a potential treatment option.
- Understanding drug penetration into cerebrospinal fluid (CSF) is crucial for efficacy.
Purpose of the Study:
- To evaluate the efficacy of intravenous amoxicillin sodium in treating pediatric bacterial meningitis.
- To measure amoxicillin penetration into CSF during treatment.
- To compare amoxicillin sodium outcomes with ampicillin.
Main Methods:
- Eleven children with bacterial meningitis received intravenous amoxicillin sodium (200 mg/kg/day for 14 days).
- CSF and serum drug levels were measured.
- Infecting organisms included Haemophilus influenzae and Streptococcus pneumoniae.
- Outcomes were compared to a historical group treated with ampicillin.
Main Results:
- Nine of eleven patients showed optimal response to amoxicillin sodium.
- CSF amoxicillin levels decreased significantly from early to late therapy (3.14 to 0.63 mug/ml).
- Treatment efficacy was comparable to ampicillin, with similar rates of neutropenia.
Conclusions:
- Intravenous amoxicillin sodium is a viable treatment for bacterial meningitis in children.
- Diminished CSF penetration over time warrants further investigation.
- Amoxicillin sodium demonstrated comparable efficacy and safety to ampicillin in this study.
Abstract:
Eleven children with bacterial meningitis were treated intravenously with amoxicillin sodium to evaluate the efficacy of the parenteral form of amoxicillin for this serious infection and to measure the penetration of the drug into cerebrospinal fluid (CSF). The infecting organisms were Haemophilus influenzae in nine cases and Streptococcus pneumoniae in two. Nine patients had optimal responses to amoxicillin sodium, 200 mg/kg per day for 14 days. Bacteria were also eradicated from CSF of the other two, but one experienced fever and culture-negative CSF pleocytosis after cessation of amoxicillin, and the other developed H. influenzae empyema 2 weeks after termination of therapy. By comparison, 7 of 10 children with meningitis responded optimally to ampicillin (nonrandomized design) during the period of study. The mean peak CSF concentration of amoxicillin was 3.14 mug/ml (ca. 7% of the concomitant mean peak serum level) early during therapy. However, meningeal penetration of the drug declined to a mean peak of 0.63 mug/ml on the final day of therapy. Mild transient neutropenia, noted in five patients, was the most common side effect of amoxicillin sodium therapy; five patients treated with ampicillin also experienced reversible neutropenia. Thus, intravenous amoxicillin sodium provided therapy for bacterial meningitis comparable to that of ampicillin in this limited case-control study.